External fixation in distal radius fractures

Background: Distal radius fractures are frequent in emergency departments, treatment is generally conservative, but there are patients who meet certain criteria of instability who need surgical treatment, including external fixation. Aim: To update on the most important elements regarding the use of external fixation in unstable fractures of the distal radius. Methods: The search and analysis of the information was carried out in a period of 30 days (from April 1 to April 30, 2021) and the following words were used: distal radius fractures, distal radius fractures and external fixation and unstable radius fractures from the information obtained, a bibliographic review of a total of 809 articles published in the PubMed databases, Hinari, SciELO and Medline was carried out using the search manager and EndNote reference manager, of which 44 selected citations were used to perform the review, 37 from the last five years. Development: The criteria to be taken into account for the instability described by various authors are indicated, as well as the imaging parameters. The two most used classification systems are mentioned. Reference is made to general surgical indications, external fixation, and placement of additional wires. Complications are discussed and a comparison is made between external fixation and blocked volar plates.

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145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

British Journal of Surgery ◽

10.1093/bjs/znab135.012 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J Mulrain ◽

K Joshi ◽

F Doyle ◽

A Abdulkarim

Keyword(s):

External Fixation ◽

Distal Radius ◽

Plate Fixation ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Plating ◽

Radius Fractures ◽

Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

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Distal radius fractures: External fixation proves best—In Reply

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(98)80031-2 ◽

1998 ◽

Vol 23 (6) ◽

pp. 1120-1121 ◽

Cited By ~ 1

Author(s):

Thomas E. Trumble

Keyword(s):

External Fixation ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures

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Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

Strategies in Trauma and Limb Reconstruction ◽

10.1007/s11751-013-0169-4 ◽

2013 ◽

Vol 8 (2) ◽

pp. 67-75 ◽

Cited By ~ 31

Author(s):

J. C. Goslings ◽

Monique M. J. Walenkamp ◽

Abdelali Bentohami ◽

M. Suzan H. Beerekamp ◽

Rolf W. Peters ◽

...

Keyword(s):

Functional Outcome ◽

External Fixation ◽

Distal Radius ◽

Locking Plate ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Plate Versus ◽

Volar Locking Plate ◽

Radius Fractures

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Biomechanical Analysis of Pin Placement and Pin Size for External Fixation of Distal Radius Fractures

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199002000-00035 ◽

1990 ◽

Vol &NA; (251) ◽

pp. 207???212

Author(s):

WILLIAM H. SEITZ ◽

AVRUM I. FROIMSON ◽

DENNIS B. BROOKS ◽

PAUL D. POSTAK ◽

RICHARD D. PARKER ◽

...

Keyword(s):

External Fixation ◽

Distal Radius ◽

Distal Radius Fractures ◽

Biomechanical Analysis ◽

Radius Fractures

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Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over

Bone & Joint Open ◽

10.1302/2633-1462.212.bjo-2021-0108.r1 ◽

2021 ◽

Vol 2 (12) ◽

pp. 1027-1034

Author(s):

Sondre Hassellund ◽

Zinajda Zolic-Karlsson ◽

John Håkon Williksen ◽

Torstein Husby ◽

Jan Erik Madsen ◽

...

Keyword(s):

Surgical Treatment ◽

Operative Treatment ◽

Distal Radius ◽

Controlled Trial ◽

Cost Effective ◽

Nonoperative Treatment ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Level Of Evidence ◽

Life Years

Aims The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis. Methods A cost-utility analysis was performed alongside a randomized controlled trial. A total of 50 patients were randomized to each group. We prospectively collected data on resource use during the first year post-fracture, and estimated costs of initial treatment, further operations, physiotherapy, home nursing, and production loss. Health-related quality of life was based on the Euro-QoL five-dimension, five-level (EQ-5D-5L) utility index, and quality-adjusted life-years (QALYs) were calculated. Results The mean QALYs were 0.05 higher in the operative group during the first 12 months (p = 0.260). The healthcare provider costs were €1,533 higher per patient in the operative group: €3,589 in the operative group and 2,056 in the nonoperative group. With a suggested willingness to pay of €27,500 per QALY there was a 45% chance for operative treatment to be cost-effective. For both groups, the main costs were related to the primary treatment. The primary surgery was the main driver of the difference between the groups. The costs related to loss of production were high in both groups, despite high rates of retirement. Retirement rate was unevenly distributed between the groups and was not included in the analysis. Conclusion Surgical treatment was not cost-effective in patients aged 65 years and older compared to nonoperative treatment of displaced distal radius fractures in a healthcare perspective. Costs related to loss of production might change this in the future if the retirement age increases. Level of evidence: II Cite this article: Bone Jt Open 2021;2(12):1027–1034.

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